Tubulointerstitial and Vascular Diseases PDF

Tubulointerstitial and Vascular Diseases Prof Dr Sülen Sarıoğlu 2024-2025 İzmir Economy University Department of Pathology  Aim: Understanding basic mechanisms of injury in renal diseases. Learning objectives: Learn the renal compartments and thei...

Tubulointerstitial and Vascular Diseases Prof Dr Sülen Sarıoğlu 2024-2025 İzmir Economy University Department of Pathology  Aim: Understanding basic mechanisms of injury in renal diseases. Learning objectives: Learn the renal compartments and their connections Learn mechanisma and morphology of Renal infections Tubulointerstitial diseases Vascular diseases  RENAL COMPARTMENTS Glomerulus Tubule Interstisyum Vascular satructures The morphology of terminally injured renal compartments Global Glomerulosklerosis Interstitial fibrosis and tubular atrophy Interstitial fibrosis Interstitial fibrosis and tubular atrophy Thickened-wrinkled basement membranes Flattened tubular epithelial cells Loss of brushborders Associated interstitial PAS fibrosis H&E Frequently associated Thyroidisation: Tubules filled with with interstitial Tamm-Horsfall protein inflammation PAMS  Vascular Structures küçük arter ve Arteriolosclerosis arteriyollerin sklerozu Atherosclerosis Intimal fatty plaque Atheroma Obliteration Mechanisms leading to injury we’ll talk about: Infections Obstructive and non-obstructive chronic pyelonephritis Vesicouretheral reflux disease (VUR) Ischemic and toxic acute tubular injury Acute and chronic interstitial nephritis Arteriolosclerosis and atherosclerosis Infections Renal infections (pelvis and calyxes) 0-1: male 1-40: female 40+: male Ascendan: E.Coli Blood borne: Staphylococcus Akut Pyelonephritis MORPHOLOGY: Gross: -Swollen and big kidney, - Cortical abscess formation, - Extensive microabscess formation - Fine lines extending to the medulla, due to collector ductus filled purulent inflammation - Pelvis, covered with inflammatory exudate - Blunting of the renal papilla Acute Pyelonephritis Acute Pyelonephritis Tubular and interstitial inflammation Microabscess formations  Complications of Acute Pyelonephritis Papillary necrosis Pyonephrosis Perinephric abscess Papillary necrosis Mostly seen in patients with diabetes mellitus, analgesic drug users and obstruction Combined supurative and ischemic necrosis of the tips of renal pyramids (papilla) Tiny necrotic parts may fall with the urinary flow. Chronic Pyelonephritis Most frequent etiologic factor in chronic renal failure Chronic obstructive pyelonephritis chronic reflux related pyelonephritis (Reflux nephropaty) Obstruction recurrent infections More frequent form renal inflammation renal scars Macroscopic findings Diffuse depressions on the renal surface Disorders in renal pelvis and calyxes  Vesicouretheral Reflux Disease (VUR) Asending infection; congenital vesicourethral valve defect /spinal cord injury-neurogenic bladder due to diabetes mellitus Residual urine after urination bacterial colonisation reflux to the ureter renal pelvis tips of the papilla (intrarenal reflux) Intrarenal reflux: most frequent at the compound papilla (at the poles) Clinical and radiologic findings are valuable Obstructive pyelonephritis Carcinoma of the urinary bladder Bilateral urethral obstruction Microscopic findings in chronic pyelonephritis Tiroidizasyon Chronic interstitial inflammation Interstitisl fibrosis Tubular atrophy Thyroidisation Hydronephrosis Hydronephrosis is a condition that occurs when a kidney swells and can't get rid of pee (urine) like it should. Dilatation in pelvis renalis, cortex and medulla gets thinner Microscopy. Atrophic changes and inflammation  Acute Tubular Necrosis Ischemic acute tubular nephropathy (all tubular regions) Toxic renal injury (proximal tubules) Most frequent reason of acute renal failure Patient history (1 week-1 month) Diagnosis: Mostly Oliguria